A 45-Year-Old Man Comes to the Office Due to Fatigue

A 45-year-old man comes to the office due to fatigue, lack of sexual desire, and inability to maintain an erection.  A year ago, he was advised to lose weight with diet and exercise due to mildly elevated fasting glucose levels.  The patient has smoked a pack of cigarettes daily for the past 20 years and drinks an alcoholic beverage 3-4 times per month.  Blood pressure is 110/70 mm Hg and pulse is 65/min.  Oxygen saturation is 99% on room air.  BMI is 29 kg/m².  Skin examination shows increased pigmentation over the knuckles and face.  The liver is palpable 3-4 cm below the right costal margin.  The remainder of the examination reveals small testes.  Which of the following is most likely contributing to the development of the patient's symptoms?

A) Aortoiliac atherosclerosis
B) Autoimmune adrenalitis
C) Ectopic ACTH production
D) Fibrosis of the seminiferous tubules
E) Iron deposition in the pituitary gland

Correct Answer:

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